The coronavirus pandemic is stressful enough, but for children and adults with autism spectrum disorder (ASD) and their families, the crisis can be especially difficult.
Dr. Eshraghi and Miller School coauthors published a new correspondence titled COVID-19: overcoming the challenges faced by individuals with autism and their families in The Lancet Psychiatry. In this commentary, the authors address specific challenges patients with autism and their families might encounter during the pandemic, as well as what healthcare providers should know and do to ensure optimal and safe care.
Chances are good that providers caring for COVID-19 patients in all settings, including the emergency room (ER) and inpatient settings, will encounter adults and children with autism.
“Autism prevalence has increased significantly in the last 20 years. In 2004, the prevalence of autism was 1 in 166. Today the Centers for Disease Control (CDC) estimates that 1 in 54 children are on the autism spectrum”, according to Dr. Eshraghi.
People with autism are at higher risk for COVID-19 complications, according to the CDC. This is because they tend to have immune disorders and other comorbidities.
The process of isolating can be especially hard on children with autism and their families. The pandemic disrupts routine, which is problematic for these patients and caregivers. Patients might have difficulty comprehending the situation and expressing themselves.
Depending on where they are on the spectrum—from extremely high to low functioning —patients might have challenges with communicating, hyperactivity, and behavioral issues. Some individuals on the spectrum are extremely sensitive to sound or bright light.
Because of all these multiple challenges which may be experienced at the same time in some instances, people with autism and their caregivers are likely experiencing heightened stress during this time.
“The healthcare environment, especially in the emergency room, can be difficult and overstimulating for people with autism spectrum disorder possibly due of the crowd, sounds and lights,” Dr. Eshraghi said. “It’s important to reduce that stress. For example, caregivers are not allowed into many ER exam and hospital rooms during the pandemic. But in the case of autism, patients need their caregivers to help keep them be calm and facilitate communication with providers.”
At a time when it is important to wear masks, children with autism might refuse or take off their masks because of sensory issues.
Potential solutions include bringing the child and caregiver to wait in an exam room, rather than keeping them in the waiting room. If the patient keeps taking off his or her mask, provide parents with additional masks to keep the child, parents, and providers safe.
Telehealth can also be a viable and promising solution, but research is needed to develop telehealth services geared specifically toward people with autism, he said. It might actually be even an opportunity for many kids on the spectrum to use these online services, even post COVID-19.
“It’s important that providers and hospital staffs not judge those parents and avoid unintentional discrimination, simply because they don’t understand the behaviors of a person on the autism,” Dr. Eshraghi said.
